POS1556-HPR RECOMMENDATIONS FOR NURSES ON THE MANAGEMENT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOUS: A DELPHI CONSENSUS
Authors: L. Cano Garcia, C. Dominguez, A. I. Rodriguez Vargas, E. Trujillo Martin, J. M. Martín Martín
Journal: Annals of the Rheumatic Diseases (2022)

Background Nurses play a key role in the management of Systemic Lupus Erythematosus (SLE) due to their close contact with the patient. Well-structured resources and specialized training are necessary to ensure comprehensive and quality care. However, no complete clinical practice guidelines for nurses have been developed for the management of SLE in Spain or Europe [1]. Objectives In this context, the OpenReuma scientific society decided to promote the RECOMIENDAles project, the aim of which is to create consensus-based recommendations for the management of SLE patients by nurses in Spain. Methods Following a bibliographic review, the Delphi method [2] was followed to reach the consensus and a structured survey was sent to nurses with expertise in SLE. Two successive rounds were conducted. Consensus was established when at least 70% of the panelists agreed or disagreed on a topic. The final questionnaire contained 90 items divided into 3 sections (Figure 1). Results In Spain, few nurses could be considered experts in SLE, hence the number of panelists was small: 25 nurses from different specialties (Rheumatology: 80%, Autoimmune Disease Units: 4%, Internal Medicine: 4%, and Day Hospital Services: 12%) with sufficient experience to ensure validated recommendations that could translate into practice. All the participants worked in public hospitals and had more than 2 years of experience treating SLE patients. A high consensus was reached on the role and responsibilities that nurses should have in relation to SLE patient management. The main results are summarized in Table 1. Table 1. Summary of the main recommendations reached in the RECOMIENDAles Project. RECOMMENDATIONS % of agreement (7 – 9 score) General recommendations •Multidisciplinary teams with at least one nurse trained in SLE 100% •Participate throughout the SLE patient care process and have their own agenda of visits and content 92% •Psychological and social worker support 96% •Access to continuous training (SLE management, individual and group counselling and communication techniques) 100% •Access to research projects 96% Specific recommendations Diagnosis: •Inform the patient about the diagnosis (manage expectations and resolve doubts and fears) 100% •Provide contact channels with the service and reliable sources of information 100% •Collaborate in the physical examination 92% •Collaborate performing diagnostic tests 76% Education: •Have a structured plan for patient education, engaging family and friends 100% •Inform about the pathology (disease course, symptoms indicating aggravation, comorbidities) 96% •Inform about healthy lifestyle habits (diet, hydration, exercise, rest patterns, photoprotection measures), avoiding toxic habits such as alcohol or smoking 100% Treatment: •Play an active role in treatment training, including self-administration and adherence monitoring 100% •Take part in the decision to introduce injectable therapy at home 76% •Prepare a youth-adult therapeutic transition plan 100% Follow-up: •Supervise patient condition to prevent comorbidities (diabetes, obesity, osteoporosis, cardiovascular problems) 96% •Promote family planning measures 100% •Monitor patient needs during the youth-adult transition 96% Conclusion Despite the high consensus achieved, to bring these recommendations to fruition it is necessary to: 1) Reinforce the role and presence of the specialized nurse in multidisciplinary teams treating SLE patients; 2) Establish a specific training plan for nurses: accredited, subsidized and supported by the Scientific Societies; and 3) Create detailed clinical practice guidelines for the SLE nurse specialist. References [1]Urizar E, Antepara C, Urtaran-Laresgoiti M, Nuño-Solinís R. Servicios de Reumatología en España: Estado de situación. 2019. [2]Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica Rand Corp [Internet]. RAND Corporation; 1969 [cited 2021 Nov 19]; Available from: https://www.rand.org/pubs/research_memoranda/RM5888.html Acknowledgements We would like to thank all the expert nurses who participated in the RECOMIENDAles Delphi Project, without whom this project would not have been possible: Ana Isabel Rodríguez Vargas (Canarias University Hospital, Santa Cruz de Tenerife); Carmen Domínguez Quesada (Virgen Macarena University Hospital, Seville); Coral Mouriño Rodríguez (do Meixoeiro Hospital, Pontevedra); Cristina Campins Reus (Manacor Hospital, Balearic Islands); Esther Vílchez Ocaña (Marítimo Torremolinos Hospital, Málaga); Idoya Piudo de Blas (Navarra Hospital Complex, Navarra); Isabel Pozo Jiménez (University Hospital of Jerez de la Frontera, Cádiz); Jenny de la Torre Aboki (General and University Hospital, Alicante); José María Martín Martín (Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife); Juan Crisostomo Vacas Pérez (Reina Sofía University Hospital, Murcia); Laura Cano García (Malaga Regional University Hospital, Malaga); Manuel Moreno Galeano (Virgen Macarena University Hospital, Seville); Maria Rodero López (San Carlos Clinical Hospital, Madrid); María Amparo Molina Tercero (University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria); María del Carmen Herrero Manso (12 de Octubre University Hospital, Madrid), Maria Dolores Aragón Álvarez (San Cecilio University Hospital, Granada); María Isabel Castro López (University Hospital Complexo of Santiago, A Coruña); María Luisa Uriondo Martínez (A Coruña University Hospital, A Coruña); Marta Rodríguez Álvarez (Burgos University Hospital, Burgos); Noor Al-Mashhandani (Civil Hospital of Malaga, Malaga); Nuria Sapena Fortea (Barcelona Clinic Hospital, Barcelona); Patricia García Casado (Ramón y Cajal University Hospital, Madrid); Rosa Serrano Loro (Germans Tries i Pujol Hospital, Barcelona); Silvia García Díaz (Sant Joan Despí Moisès Broggi Hospital, Barcelona) and Susana Fernández Sánchez (Santa Creu and Sant Pau Hospital, Barcelona). We would like to thank GSK for its financial support to this project. We would also like to thank Adelphi Targis S.L. for the logistical support provided to develop the project. Disclosure of Interests Laura Cano Garcia Consultant of: GSK, fees for her advice as a member of the Scientific Committee of the RECOMIENDAles Project., Carmen Dominguez Consultant of: GSK, fees for her advice as a member of the Scientific Committee of the RECOMIENDAles Project., Ana Isabel Rodriguez Vargas Consultant of: GSK, fees for her advice as a member of the Scientific Committee of the RECOMIENDAles Project., ELISA TRUJILLO MARTIN Consultant of: GSK, fees for her advice as a member of the Scientific Committee of the RECOMIENDAles Project., José Maria Martín Martín Consultant of: GSK, fees for his advice as a member of the Scientific Committee of the RECOMIENDAles Project.